Cellulitis-like cutaneous cryptococcosis revealing disseminated infection in a kidney transplant recipient: a case report and systematic review.
BACKGROUND Cryptococcosis is an opportunistic infection increasingly recognized among kidney transplant recipients (KTR), often presenting with heterogeneous and misleading clinical manifestations. Cutaneous involvement is uncommon but may represent an early sign of disseminated disease, posing significant diagnostic challenges. METHODS We report a case of disseminated Cryptococcus neoformans infection occurring shortly after ABO-incompatible kidney transplantation and performed a systematic review of the literature according to PRISMA guidelines. Published reports describing KTR with microbiologically and/or histopathologically confirmed cryptococcosis and documented cutaneous involvement were included. Clinical characteristics, diagnostic findings, treatment, and outcomes were extracted and analyzed. RESULTS A total of 65 studies comprising 72 KTR were included; with the present case, 73 patients were analyzed. Disseminated disease was observed in (49/73, 67.1%) cases. Cutaneous lesions represented the initial manifestation in the majority of disseminated cases (34/49, 69.4%). The most frequent extracutaneous sites were the central nervous system (32/49, 65.3%), lungs (23/49, 46.9%), and bloodstream (19/49, 38.7%). Clinical presentation was highly heterogeneous, with cellulitis-like lesions being the most common (36/73, 49.3%), often leading to misdiagnosis and delayed antifungal therapy. Diagnosis relied primarily on skin histology, culture, and cryptococcal antigen testing. Most patients received amphotericin B-based regimens followed by azole-based consolidation therapy. Overall, 60/73 (82.2%) patients achieved clinical recovery, although mortality remained substantial, particularly in disseminated disease. CONCLUSIONS Among published cases, cutaneous cryptococcosis most commonly occurred in the setting of disseminated infection. Given its polymorphic presentation and frequent mimicry of bacterial skin infections, a high index of suspicion and prompt diagnostic evaluation are essential to ensure early recognition and improve clinical outcomes.